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General NPI Number Information
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NPI Number | 1780955575
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Entity Type | Organization
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Legal Business Name | COLLAZO OPHTHALMOLOGY & OPTOMETRY
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Dates
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Enumeration Date | 01/25/2012
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Last Update Date | 04/25/2013
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Provider Practice Location Address
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Address Line | 4231 N 5TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19140-2602
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Country | US
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Telephone | 215-455-1010
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1141
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City | BALA CYNWYD
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State | PA
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Zip | 19004-5141
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Country | US
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Telephone | 215-455-1010
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Fax | 215-732-8656
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. RAFAEL S COLAZZO
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Credential | OD
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Telephone | 215-455-1010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | OE006393T
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | OE006393T
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OE006393T
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License Number State | PA
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